Saturday, June 14, 2008

Are 18 Million Americans Uninsured Voluntarily?

According to this Census Bureau report (most recent data available), there were about 47 million uninsured Americans in 2006. The chart above shows the household income levels of those 47 million uninsured Americans. There are 9,283,000 uninsured Americans living in households that make $75,000 or more, and this represents about 20% of the total number of uninsured. There are about 8.5 million American without health insurance in households making between $50,000 and $75,000. With those two groups combined, 38% of Americans without health insurance (almost 18 million people) lived in households with $50,000 or more of household income in 2006.

Q: With $50,000 or more in household income, wouldn't many of those 18 million uninsured be without insurance voluntarily? That is, couldn't most of those households afford health insurance?

In Michigan, you can get basic health insurance through Blue Cross starting at $47.14 per month for those 18-30 years old (about the cost of a basic cell phone plan), and for $138.54 per month for individuals under 65 (not too much more than a cable TV plan with premium channels, and less than two cells phones at the monthly average of $77).

Since most households making $50,000 or more can afford multiple cell phones and cable TV, it would seem like they could also afford basic health insurance, and choose not to buy it. If they say they can't afford health insurance, they should consider cancelling their cell phones and/or their cable TV service. If they choose cell phones and cable TV over health insurance, that's a voluntary choice.

My insurance payments are over $2000 for me, my wife and four children. It is so difficult for me to discover the costs of medical care that I do not bother. I would rather be uninsured, but my wife insists otherwise.

The quoted rates in your article are soft quotes - quotes without any underwriting. I applied for an $80/mo HSA and was referred to the state high risk pool at four times the cost, higher deductible, and $20,000 out of pocket. My pre-existing condition - infertily, which was never included in prior plans and excluded in the one I wanted.

Many people like to point to the quotes on websites and compare it to things like ipods and cell phones, but there is really no comparison. In one case you have a product in hand in the other you have to literally beg for it. The insurance companies take your money and run.

Yes, I am technically uninsured by choice. Some choice. Go bankrupt paying for the insurance. Go bankrupt begging for the insurance company to cover anything. Or go bankrupt paying for a medical catastrophe. I would rather keep my money than hand it over to a shark.

> That, Sir is an impossible question to answer based on the data presented.

No it's not.

It's bleeding obvious.

If someone has the income to buy insurance, but chooses to instead buy a new TV, or a new car, or spend the money on a host of other desirable (but far less "needful" expenditures), then that is their choice -- it is particularly relevant, though, when one is considering the need to push for "universal" health care. They are choosing to bet that their medical expenses will be less than that of the insurance, so they can divert the savings to other things they believe will benefit them more.

The only people you have any business arguing for "universal" health care on behalf of are the ones who legitimately are not making that choice because their income is spent on food, or clothing, or basic housing (fixing up a house in no "disrepair", like remodelling the bathroom because you never liked the wallpaper, doesn't count).

That doesn't make the argument valid, but it does open it to being valid, which is something including "the choosers" in the statistics of is blatantly faulty.

Dental insurance is almost always a rip, anyway. Typ. you are paying three times as much for nothing but cleanings, and they don't pay out anything more than the money you put into it unless you have 3-4 substantial dental problems a year (adn even that is highly limited in coverage)

If you have reasonably good teeth, and take reasonably good care, it's stupid to have it at all.

It may have served a purpose in the days before fluoridation, but nowadays most people who have bad teeth, i.e., major dental problems, it's because they ignore them in the first place.

Note: Yes, there are exceptions. If that applies, I'm not talking about *you*.

Many people cannot buy insurance at any price, because of pre-existing conditions. I suspect most of these relatively high income people fall into this category. It would be interesting to have more data, but you cannot assume that they have instead decided to spend their money on cell phones and HDTVs.

This paper from actuary.org talks about the different categories of the uninsured, including the voluntary uninsured... and there's a nice little diagram on page 4, but, unfortunately, not actual numbers... except here:

"While almost all large employers offer health coverage, an increasing number of their employees remain without coverage... Twenty percent of uninsured employees did not elect coverage even when their employer offered it. More than half those refusing coverage said their required contribution was too expensive. Low-income employees and those under age 25 had the lowest take-up rates."

At my large company, most employees opt for the most expensive coverage (low or no deductable) and complain about the high cost. We try to convince them that high deductable coverage would be better for them - it is cheaper and still has very low (lower) co-pays per visit, but they don't want it. To put it bluntly, they are being stupid. They are costing themselves and the company a great deal of money for something they don't need.

At the same time, we can't get people to put money in their 401k. We advertise, educate, etc., but people just don't get what a good deal it is, especially with employee matching funds. Again, they are being stupid (defined as not acting in their long term interest - short time horizon maybe?).

While the chart is great, what it fails to account for is that most people choose to make less than 75k a year. That's right, not only do they choose not to get insurance, but they choose to make less money. Not everyone, some people have disabilities or very very bad luck. Most people, however, believe the nonesense they teach in school about "finding something you love" and "be someone special, be yourself". This leads them to majors in college like photography, education, philosophy (fell for that one myself) and other such things that are likely to lead to poor paying jobs. People were never taught that you can tell how much society needs a particular job by how much it pays. Simple Hayek price signal stuff. Should be taught in 3rd grade.

So, if you want health insurance, maybe you should work hard and smart to get a better job. Same with gas prices. Same with other disasters. The best thing you can do for yourself and your family is make lots of money so you can car for them.

Also, the government should stop messing up the health care system. Especially with medicare and medicade. Totally screwing up the price signals. Also, delink health insurance from employment. Stop taxing pay!

Household income does not necessarily translate to disposable income. A household income of 50K with how many dependents/ members of household? If that is 50K for a single person it is strikingly different than 50K, family of four living in an expensive area like Boston, NYC, or LA. 50K in the rural areas may be excellent. I think the data you present are inadequate. Household income isn't as relevant as PER CAPITA income and cost of living factors, to determine whether being uninsured is voluntary.

Yes they are. Your statements are very misleading however. You talk family incomes and individual best case ,price leader, prices. I chose not to buy insurance. I could but it for my family for $500/month with a $15,000 per person per year deductible. That would be a stupid purchase. There are only a few possible scenarios in which I would be glad to have that insurance. The real problem is the cost of medicine. One of the 4 biggest causes of high medical costs is insurance.

Everyone has choices to make in life. I know there are families financially strapped because of current conditions, but why would one have a family of 4 if you cannot take care of their health care and financial needs. Be responsible for your actions

I don't get it. I'm a musician and I earn barely 25K a year. How come I don't feel entitled to anybody else's money? I could at any second, go to a junior college, transfer to a better institution, get a flashy degree and not have to get a handout. Whatever happened to the American institution of self determination and self accountability? If I impregnated four girls and ended up with a whole lot of kids and child support, that sucks balls, but that's life. Pretty much everyone in my family worked their way up from below the poverty line to live a comfortable lifestyle. Without handouts and by working hard. I know there's this "Eat The Rich" Mike Moore attitude everywhere and it's spoiled nonsense. You think life is hard in America? Forget it. That one trillion dollars for the reform could save literally hundreds of millions of lives in Africa. Thousands die everyday from Malaria. Screw insurance, they need one relatively cheap drug. How come none of these guys that are campaigning to get free healthcare are campaigning for helping non americans? At the end of the day it's a "I want this" scenario, not a help your brother scenario. Just as greedy as the successful capitalists they say they hate.